Subcentimeter pulmonary nodules are not associated with disease progression in patients with renal cell carcinoma

Roy Mano, Emily Vertosick, Alexander I. Sankin, Michael S. Chevinsky, Yaniv Larish, Christopher D. Jakubowski, Andreas M. Hötker, A. Ari Hakimi, Daniel D. Sjoberg, Oguz Akin, Paul Russo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: Renal cell carcinoma most commonly metastasizes to the lung. Indeterminate pulmonary nodules develop preoperatively in half of the patients with localized renal cell carcinoma but clinical significance remains poorly defined. We determined whether the presence of indeterminate pulmonary nodules, or nodule size or number is associated with renal cell carcinoma outcomes. Materials and Methods: We reviewed data on 1,102 patients with renal cell carcinoma in whom chest computerized tomography was done within 6 months before nephrectomy from 2002 to 2012. Patients with metastatic disease at presentation, benign tumors, pulmonary nodules greater than 2 cm or concurrent pulmonary disease were excluded, leaving 748 available for analysis. Study outcomes included lung metastasis, any distant metastasis or death from renal cell carcinoma. Cox proportional hazards models were used to assess whether the presence of indeterminate pulmonary nodules, or nodule size or number was associated with outcomes. Models were evaluated by comparing discrimination using the Harrell c-index. Results: Indeterminate pulmonary nodules were present in 382 of 748 patients (51%). Median followup was 4.1 years (IQR 2.2-6.1). The presence of indeterminate pulmonary nodules was not associated with distant metastasis or death from kidney cancer. However, compared to subcm indeterminate pulmonary nodules the nodules greater than 1 cm were associated with metastatic disease after adjusting for tumor histology, stage and size (HR 2.48, 95% CI 1.08-5.68, p = 0.031). The outcome c-index increased slightly after adding nodule size to a predictive model adjusted for tumor characteristics. Conclusions: No evidence in the current study suggested that indeterminate pulmonary nodules less than 1 cm are associated with renal cell carcinoma progression, although large nodules significantly predicted metastatic disease. Patients with subcm indeterminate pulmonary nodules would be unlikely to benefit from extensive postoperative chest imaging surveillance, which should be reserved for patients with nodules greater than 1 cm.

Original languageEnglish (US)
Pages (from-to)776-782
Number of pages7
JournalJournal of Urology
Volume193
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Renal Cell Carcinoma
Disease Progression
Lung
Neoplasm Metastasis
Thorax
Neoplasms
Kidney Neoplasms
Nephrectomy
Proportional Hazards Models
Lung Diseases
Histology
Tomography
Outcome Assessment (Health Care)

Keywords

  • carcinoma, renal cell
  • kidney
  • lung
  • neoplasm metastasis
  • tomography, emission-computed

ASJC Scopus subject areas

  • Urology

Cite this

Subcentimeter pulmonary nodules are not associated with disease progression in patients with renal cell carcinoma. / Mano, Roy; Vertosick, Emily; Sankin, Alexander I.; Chevinsky, Michael S.; Larish, Yaniv; Jakubowski, Christopher D.; Hötker, Andreas M.; Hakimi, A. Ari; Sjoberg, Daniel D.; Akin, Oguz; Russo, Paul.

In: Journal of Urology, Vol. 193, No. 3, 01.03.2015, p. 776-782.

Research output: Contribution to journalArticle

Mano, R, Vertosick, E, Sankin, AI, Chevinsky, MS, Larish, Y, Jakubowski, CD, Hötker, AM, Hakimi, AA, Sjoberg, DD, Akin, O & Russo, P 2015, 'Subcentimeter pulmonary nodules are not associated with disease progression in patients with renal cell carcinoma', Journal of Urology, vol. 193, no. 3, pp. 776-782. https://doi.org/10.1016/j.juro.2014.09.020
Mano, Roy ; Vertosick, Emily ; Sankin, Alexander I. ; Chevinsky, Michael S. ; Larish, Yaniv ; Jakubowski, Christopher D. ; Hötker, Andreas M. ; Hakimi, A. Ari ; Sjoberg, Daniel D. ; Akin, Oguz ; Russo, Paul. / Subcentimeter pulmonary nodules are not associated with disease progression in patients with renal cell carcinoma. In: Journal of Urology. 2015 ; Vol. 193, No. 3. pp. 776-782.
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abstract = "Purpose: Renal cell carcinoma most commonly metastasizes to the lung. Indeterminate pulmonary nodules develop preoperatively in half of the patients with localized renal cell carcinoma but clinical significance remains poorly defined. We determined whether the presence of indeterminate pulmonary nodules, or nodule size or number is associated with renal cell carcinoma outcomes. Materials and Methods: We reviewed data on 1,102 patients with renal cell carcinoma in whom chest computerized tomography was done within 6 months before nephrectomy from 2002 to 2012. Patients with metastatic disease at presentation, benign tumors, pulmonary nodules greater than 2 cm or concurrent pulmonary disease were excluded, leaving 748 available for analysis. Study outcomes included lung metastasis, any distant metastasis or death from renal cell carcinoma. Cox proportional hazards models were used to assess whether the presence of indeterminate pulmonary nodules, or nodule size or number was associated with outcomes. Models were evaluated by comparing discrimination using the Harrell c-index. Results: Indeterminate pulmonary nodules were present in 382 of 748 patients (51{\%}). Median followup was 4.1 years (IQR 2.2-6.1). The presence of indeterminate pulmonary nodules was not associated with distant metastasis or death from kidney cancer. However, compared to subcm indeterminate pulmonary nodules the nodules greater than 1 cm were associated with metastatic disease after adjusting for tumor histology, stage and size (HR 2.48, 95{\%} CI 1.08-5.68, p = 0.031). The outcome c-index increased slightly after adding nodule size to a predictive model adjusted for tumor characteristics. Conclusions: No evidence in the current study suggested that indeterminate pulmonary nodules less than 1 cm are associated with renal cell carcinoma progression, although large nodules significantly predicted metastatic disease. Patients with subcm indeterminate pulmonary nodules would be unlikely to benefit from extensive postoperative chest imaging surveillance, which should be reserved for patients with nodules greater than 1 cm.",
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AU - Mano, Roy

AU - Vertosick, Emily

AU - Sankin, Alexander I.

AU - Chevinsky, Michael S.

AU - Larish, Yaniv

AU - Jakubowski, Christopher D.

AU - Hötker, Andreas M.

AU - Hakimi, A. Ari

AU - Sjoberg, Daniel D.

AU - Akin, Oguz

AU - Russo, Paul

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N2 - Purpose: Renal cell carcinoma most commonly metastasizes to the lung. Indeterminate pulmonary nodules develop preoperatively in half of the patients with localized renal cell carcinoma but clinical significance remains poorly defined. We determined whether the presence of indeterminate pulmonary nodules, or nodule size or number is associated with renal cell carcinoma outcomes. Materials and Methods: We reviewed data on 1,102 patients with renal cell carcinoma in whom chest computerized tomography was done within 6 months before nephrectomy from 2002 to 2012. Patients with metastatic disease at presentation, benign tumors, pulmonary nodules greater than 2 cm or concurrent pulmonary disease were excluded, leaving 748 available for analysis. Study outcomes included lung metastasis, any distant metastasis or death from renal cell carcinoma. Cox proportional hazards models were used to assess whether the presence of indeterminate pulmonary nodules, or nodule size or number was associated with outcomes. Models were evaluated by comparing discrimination using the Harrell c-index. Results: Indeterminate pulmonary nodules were present in 382 of 748 patients (51%). Median followup was 4.1 years (IQR 2.2-6.1). The presence of indeterminate pulmonary nodules was not associated with distant metastasis or death from kidney cancer. However, compared to subcm indeterminate pulmonary nodules the nodules greater than 1 cm were associated with metastatic disease after adjusting for tumor histology, stage and size (HR 2.48, 95% CI 1.08-5.68, p = 0.031). The outcome c-index increased slightly after adding nodule size to a predictive model adjusted for tumor characteristics. Conclusions: No evidence in the current study suggested that indeterminate pulmonary nodules less than 1 cm are associated with renal cell carcinoma progression, although large nodules significantly predicted metastatic disease. Patients with subcm indeterminate pulmonary nodules would be unlikely to benefit from extensive postoperative chest imaging surveillance, which should be reserved for patients with nodules greater than 1 cm.

AB - Purpose: Renal cell carcinoma most commonly metastasizes to the lung. Indeterminate pulmonary nodules develop preoperatively in half of the patients with localized renal cell carcinoma but clinical significance remains poorly defined. We determined whether the presence of indeterminate pulmonary nodules, or nodule size or number is associated with renal cell carcinoma outcomes. Materials and Methods: We reviewed data on 1,102 patients with renal cell carcinoma in whom chest computerized tomography was done within 6 months before nephrectomy from 2002 to 2012. Patients with metastatic disease at presentation, benign tumors, pulmonary nodules greater than 2 cm or concurrent pulmonary disease were excluded, leaving 748 available for analysis. Study outcomes included lung metastasis, any distant metastasis or death from renal cell carcinoma. Cox proportional hazards models were used to assess whether the presence of indeterminate pulmonary nodules, or nodule size or number was associated with outcomes. Models were evaluated by comparing discrimination using the Harrell c-index. Results: Indeterminate pulmonary nodules were present in 382 of 748 patients (51%). Median followup was 4.1 years (IQR 2.2-6.1). The presence of indeterminate pulmonary nodules was not associated with distant metastasis or death from kidney cancer. However, compared to subcm indeterminate pulmonary nodules the nodules greater than 1 cm were associated with metastatic disease after adjusting for tumor histology, stage and size (HR 2.48, 95% CI 1.08-5.68, p = 0.031). The outcome c-index increased slightly after adding nodule size to a predictive model adjusted for tumor characteristics. Conclusions: No evidence in the current study suggested that indeterminate pulmonary nodules less than 1 cm are associated with renal cell carcinoma progression, although large nodules significantly predicted metastatic disease. Patients with subcm indeterminate pulmonary nodules would be unlikely to benefit from extensive postoperative chest imaging surveillance, which should be reserved for patients with nodules greater than 1 cm.

KW - carcinoma, renal cell

KW - kidney

KW - lung

KW - neoplasm metastasis

KW - tomography, emission-computed

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